National Center for Image Guided Therapy, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Department of Urology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan.
J Robot Surg. 2023 Aug;17(4):1411-1420. doi: 10.1007/s11701-023-01530-0. Epub 2023 Jan 23.
Our objective was to evaluate the feasibility of a multi-section continuum robotic ureteroscope to address the difficulties with access into certain renal calyces during flexible ureteroscopy. First, the robotic ureteroscope developed in previous research, which utilizes three actuated bendable sections controlled by wires, was modified for use in this project. Second, using phantom models created from five randomly selected computer tomography urograms, the flexible ureteroscope and robotic ureteroscope were evaluated, focusing on several factors: time taken to access each renal calyx, time taken to aim at three targets on each renal calyx, the force generated in the renal pelvic wall associated with ureteroscope manipulation, and the distance and standard deviation between the ureteroscope and the target. As a result, the robotic ureteroscope utilized significantly less force during lower pole calyx access (flexible ureteroscope vs. robotic ureteroscope; 2.0 vs. 0.98 N, p = 0.03). When aiming at targets, the standard deviation of proper target access was smaller for each renal calyx (upper pole: 0.49 vs. 0.11 mm, middle: 0.84 vs. 0.12 mm, lower pole: 3.4 vs. 0.19 mm) in the robotic ureteroscope group, and the distance between the center point of the ureteroscope image and the target was significantly smaller in the robotic ureteroscope group (upper: 0.49 vs. 0.19 mm, p < 0.001, middle: 0.77 vs. 0.17 mm, p < 0.001, lower: 0.77 vs. 0.22 mm, p < 0.001). In conclusion, our robotic ureteroscope demonstrated improved maneuverability and facilitated accuracy and precision while reducing the force on the renal pelvic wall during access into each renal calyx.
我们的目标是评估多节连续体机器人输尿管镜在解决软式输尿管镜检查中进入某些肾盏困难的可行性。首先，对之前研究中开发的机器人输尿管镜进行了修改，该输尿管镜使用三个由线控制的可弯曲的主动弯曲部分。其次，使用从五个随机选择的计算机断层尿路造影图像创建的体模，评估了柔性输尿管镜和机器人输尿管镜，重点关注几个因素：进入每个肾盏所需的时间、瞄准每个肾盏上的三个目标所需的时间、与输尿管镜操作相关的肾盂壁产生的力，以及输尿管镜和目标之间的距离和标准差。结果，机器人输尿管镜在进入下极盏时使用的力显著较小（柔性输尿管镜与机器人输尿管镜；2.0 与 0.98 N，p = 0.03）。在瞄准目标时，每个肾盏适当目标进入的标准偏差较小（上极：0.49 与 0.11 mm，中极：0.84 与 0.12 mm，下极：3.4 与 0.19 mm）在机器人输尿管镜组中，并且输尿管镜图像中心点与目标之间的距离在机器人输尿管镜组中显著较小（上极：0.49 与 0.19 mm，p < 0.001，中极：0.77 与 0.17 mm，p < 0.001，下极：0.77 与 0.22 mm，p < 0.001）。总之，我们的机器人输尿管镜在进入每个肾盏时表现出更好的操纵性，提高了准确性和精密度，同时减少了肾盂壁上的力。
